Provider Demographics
NPI:1932874120
Name:CANTOR, JASON LEE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:CANTOR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1830 WELLS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2365
Mailing Address - Country:US
Mailing Address - Phone:808-856-4060
Mailing Address - Fax:808-442-9670
Practice Address - Street 1:1830 WELLS ST STE 101
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2365
Practice Address - Country:US
Practice Address - Phone:808-856-4060
Practice Address - Fax:808-442-9670
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAMD-1067-0363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant